What Causes Sleep Trouble After a Hysterectomy?

A hysterectomy is often necessary, but comes with an assortment of risks and potential complications.

While it’s not the most common issue, some women do develop sleep trouble, and even insomnia after having a hysterectomy.

We’ll review the available research on this topic on this page.

Consequences of a Hysterectomy

Most physicians prefer to avoid hysterectomies whenever there’s an alternative possible. Fewer hysterectomies are performed than in the past, and that number will likely continue to fall.

But for now, there are some good reasons that hysterectomies are still performed:

• Alleviating chronic pelvic pain - About 15% of women suffer from chronic pelvic pain, and a hysterectomy is one potential treatment option (1).
• Improving sleep - While hysterectomies cause sleep issues in some women, they can also improve existing sleep issues in others (2).
• Urinary function - A hysterectomy has been shown to improve urinary function in women with uterine fibroids or other issues (2).
• Cancer - In the case of gynecologic cancer, a hysterectomy is often necessary.

Risks

While there are several risks of a hysterectomy (and of any surgery in general), there are a few that could end up impacting your sleep:

• Lower estrogen levels - If ovaries are removed in the hysterectomy, estrogen levels drastically fall. As we’ll discuss shortly, levels of hormones like estrogen can impact your sleep (3).
• Lower bone density - Hysterectomies come with a greater risk of osteoporosis and bone fractures. Any skeletal injury has the potential to greatly impact sleep quality (4,5).
• Urinary incontinence - While it doesn’t affect all women, a hysterectomy significantly increases the risk of developing urinary incontinence (6). Women who had their ovaries removed do not appear to be at as high of a risk for urinary incontinence (7).

SummaryLike any surgery, a hysterectomy carries risks. While it will improve sleep for some women, there are multiple reasons that a hysterectomy could cause sleep issues.

Why Would a Hysterectomy Cause Sleep Trouble?

Women are more likely to have insomnia than men, mostly because of hormonal causes.

Hormones (not only testosterone and estrogen, but also melatonin, cortisol, and others) play a vital role in regulating sleep.

Too much or too little of a certain hormone (an endocrine imbalance) that our bodies are expecting, can cause significant sleep issues.

Common symptoms of a hormonal imbalance include (8):

• Fatigue
• Muscle weakness
• Muscle aches, tenderness, and stiffness
• Joint pain, stiffness, or swelling
• Increased or decreased heart rate
• Increased temperature sensitivity
• Weight changes

Beyond some obvious cause like bone pain or having to wake up frequently to go to the bathroom, most sleep trouble from a hysterectomy comes from a lower level of estrogen.

A women’s circadian rhythm throughout their life expects a certain level of estrogen, and then all of a sudden it plummets.

This can also cause rapid onset of menopausal symptoms like hot flashes. Changes in body temperature can also disrupt your sleep cycle.

SummaryWhile there are a few different ways a hysterectomy can cause sleep issues, the drastic change in estrogen production is the most common cause if no other obvious cause can be identified.

Does It Matter if the Ovaries Were Removed?

Ovaries are not always removed in hysterectomies (it’s a case-by-case decision), and that can potentially be a good thing since they are the main producers of one the main types of estrogen in the body (9).

Research suggests that leaving ovaries intact during this surgery can improve long-term survival rates (10).

They can still produce estrogen and testosterone in significant amounts (even after menopause), which is important for heart and bone health (11).

SummaryWomen who don’t have ovaries removed during a hysterectomy are less likely to have sleep issues, but it’s still possible.

How Common is Insomnia After a Hysterectomy?

Sleep issues aren’t the most common complaint after a hysterectomy, but a significant amount of women do develop them.

A self-reported questionnaire found that roughly 70% of hysterectomy patients experienced (12):

• Hot flushes
• Urinary symptoms
• Extreme tiredness postoperatively

About half experienced:

• Headaches
• Dizziness
• Insomnia

In this patient cohort, the most likely explanation was concluded to be endocrine (hormone) imbalance.

Will Sleep Trouble Go Away By Itself?

How sleep issues will develop is tricky to predict.

Sleep problems caused by short term triggers like stress or an injury usually resolve on their own. However, the sleep issues themselves can cause more anxiety and stress, which can snowball into chronic insomnia.

When it comes to a hormone imbalance, the body may adjust over time to new hormone levels, depending on the severity of the imbalance.

This is an issue that must be looked at with a physician. If it is concluded that someone’s insomnia is caused by low levels of estrogen following a hysterectomy, hormone therapy is a potential treatment option (13).

References

1. Chronic Pelvic Pain: An Integrated Approach to Diagnosis and Treatment
2. Are the Physiologically and Psychosocially Based Symptoms in Women Suffering from Gynecological Disorders Alleviated by Means of Hysterectomy?
3. Hysterectomy and risk of cardiovascular disease: a population-based cohort study
4. Risk Factors for Osteoporosis Related to their Outcome: Fractures
5. Risk factors for pelvis fracture in older persons
6. Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study
7. Self-reported bladder function five years post-hysterectomy
8. Everything You Should Know About Hormonal Imbalance
9. Sources of estrogen and their importance
10. Keeping Your Ovaries if You Are Having a Hysterectomy
11. Ovarian Conservation at the Time of Hysterectomy for Benign Disease
12. A Post-Hysterectomy Syndrome
13. Options for hormone therapy in women who have had a hysterectomy